Editorial: Not perfection, but progress

With its vital signs weakening dangerously, the patient - America's $2.5 trillion health-care system - finally has been rolled into the operating room.

Were he a surgeon, President Obama would be scrubbed and gloved now. And not a moment too soon: Each day, 14,000 people lose their coverage, amid double-digit increases for medical care.

While Obama stumbled before now by diagnosing the patient's ills rather than prescribing a cure, this past week he set out a detailed course of treatment that just might work. Its worthy goals: assure access to coverage for every citizen - including the 46 million uninsured - improve quality, and drive down rising costs.

Democrats in Congress, if not Republicans, seem ready to flip on the bright operating lights.

So the long, hot summer appears over for health-care reform, even if the misinformation campaign continues in a desperate effort to derail that effort.

In fact, Congressional Republicans and their allies hardly missed a beat. Rep. Joe Wilson of South Carolina set the tone with his shouted "You lie!" during the president's speech to Congress Wednesday, and it was downhill from there.

Despite facts to the contrary, House Minority Leader John A. Boehner (R., Ohio) on Thursday kept peddling the notion that Democrats would provide illegal immigrants coverage - that's what set off Wilson - fund abortions, and ration end-of-life care.

The official Republican speech "response" was almost laughable, since it warned against "replacing your family's current health care with government-run health care." Yet Obama had said within the hour that "nothing in this plan will require you or your employer to change the coverage or the doctor you have."

Even though GOP leaders covered their ears, millions of Americans - insured or not - now have a clear stake in the plan Obama outlined. (Essentially, the same plan is expected to take shape in the Senate next week.)

Key reforms would bar discrimination by insurance companies over preexisting conditions, prevent them from dropping people with serious illnesses, sets caps on patient expenses, and expand seniors' Medicare drug coverage.

The plan endorses most other key elements: providing subsidies to low-income families needing insurance, requiring everyone to carry coverage, incentives for employers to maintain coverage, and fees on insurers to help pay.

Obama pretty much put the bogeyman of a government-run insurance plan under house arrest, suggesting as an alternative a new insurance marketplace to promote competition. It would be better to keep a public plan as a fallback, but it's not worth sacrificing the overall reform.

There remains a real question on cost controls, despite Obama's pledge to avoid hiking deficits by "one dime." Among health-care experts, it's pretty much an article of faith that costs will be tamed only by tackling the system's fee-for-service. But neither the president nor Congress has proposed that yet.

As Obama said, prompting laughter, "There remain some significant details to be ironed out." But Democrats, who clearly will have to go it alone now, should be encouraged by the remarkable consensus that exists among health-care stakeholders over the broad outlines of reform that Obama, at long last, has embraced.